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Consideration of Cost of Care in Pediatric Emergency Transfer-An Opportunity for Improvement
Rajender K Gattu1, Ann-Sophie De Fee, Richard Lichenstein
1From the Division of Pediatric Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
Insights
Many pediatric interhospital transfers are unnecessary and costly. A significant portion of these transfers resulted in patients being discharged within 12 hours, highlighting potential cost savings through improved transfer protocols.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Economics
- Health Services Research
Background:
- Pediatric interhospital transfers represent a significant economic burden on healthcare systems.
- Unnecessary transfers contribute to increased costs, with physicians potentially unaware of the financial implications.
- Cost analysis is crucial for identifying areas to reduce expenditure in pediatric emergency care.
Purpose of the Study:
- To analyze children transferred to a pediatric emergency department (PED) from outlying emergency departments (EDs).
- To specifically examine transfers discharged within 12 hours without intervention in the PED.
- To determine the associated financial charges for these specific patient transfers.
Main Methods:
- Retrospective chart review of 352 pediatric patients (0-18 years) transferred between July 2009 and June 2010.
- Data collection included service charges, volume, length of stay, and patient disposition.
- Calculation of average charges per transfer, differentiating between fixed and variable costs.
Main Results:
- Out of 352 transfers, 166 (47.2%) were discharged home, with 101 (28.7%) discharged within 12 hours without intervention.
- The average hospital charge per transfer was $4843.
- Transfers discharged within 12 hours without intervention incurred charges totaling $489,143.
Conclusions:
- A substantial number of pediatric transfers are discharged within 12 hours without further intervention.
- Fixed costs constitute the majority of total hospital charges for these transfers.
- Preventing unnecessary interhospital transfers offers a clear opportunity for significant cost savings.
Background:
Pediatric interhospital transfers are an economic burden to the health care, especially when deemed unnecessary. Physicians may be unaware of the cost implications of pediatric emergency transfers. A cost analysis may be relevant to reduce cost.
Objective:
To characterize children transferred from outlying emergency departments (EDs) to pediatric ED (PED) with a specific focus on transfers who were discharged home in 12 hours or less after transfer without intervention in PED and analyze charges associated with them.
Methods:
Charts of 352 patients (age, 0-18 years) transferred from 31 outlying EDs to PED during July 2009 to June 2010 were reviewed. Data were collected on the range, unit charge and volume of services provided in PED, length of stay, and final disposition. The average charge per patient transfer is calculated based on unit charge times total service units per 1000 patients per year and divided by 1000. Hospital charges were divided into fixed and variable.
Results:
Of 352 patients transferred, 108 (30.7%) were admitted to pediatric inpatient service, 42 (11.9%) to intensive care; 36 (10.2%) went to the operating room, and 166 (47.2%) were discharged home. The average hospital charge per transfer was US $4843. Most (89%) of the charges were fixed, and 11% were variable. One hundred one (28.7%) patients were discharged home from PED in 12 hours or less without intervention. The hospital charges for these transfers were US $489,143.
Conclusions:
Significant number of transfers was discharged 12 hours or less without any additional intervention in PED. Fixed charges contribute to majority of total charges. Cost saving can be achieved by preventing unnecessary transfer.
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